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Lancet Neurol. 2016 Sep;15(10):1075-88. doi: 10.1016/S1474-4422(16)30158-2. Epub 2016 Aug 8.

Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention.

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Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Medical Center, New York, NY, USA. Electronic address:
Gertrude H Sergievsky Center and Department of Epidemiology, Columbia University, New York, NY, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Neurology, University Hospitals, Case Medical Center, Cleveland, OH, USA.
Department of Neurology, University of Iowa, Veteran's Affairs Medical Center, Iowa City, IA, USA; Department of Molecular Physiology and Biophysics, University of Iowa, Veteran's Affairs Medical Center, Iowa City, IA, USA.


Sudden unexpected death in epilepsy (SUDEP) can affect individuals of any age, but is most common in younger adults (aged 20-45 years). Generalised tonic-clonic seizures are the greatest risk factor for SUDEP; most often, SUDEP occurs after this type of seizure in bed during sleep hours and the person is found in a prone position. SUDEP excludes other forms of seizure-related sudden death that might be mechanistically related (eg, death after single febrile, unprovoked seizures, or status epilepticus). Typically, postictal apnoea and bradycardia progress to asystole and death. A crucial element of SUDEP is brainstem dysfunction, for which postictal generalised EEG suppression might be a biomarker. Dysfunction in serotonin and adenosine signalling systems, as well as genetic disorders affecting cardiac conduction and neuronal excitability, might also contribute. Because generalised tonic-clonic seizures precede most cases of SUDEP, patients must be better educated about prevention. The value of nocturnal monitoring to detect seizures and postictal stimulation is unproven but warrants further study.

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